Approach-Avoidance and Alcohol Challenge Study in PTSD

The proposed study will test the conceptual model positing that acute alcohol alters the relative bias in computational mechanisms for threat vs reward, thereby decreasing avoidance to threat and increasing approach to reward in adults with PTSD, and through this mechanism increases risk for heavier alcohol use over time. Research aims are to identify alcohol-induced changes in approach-avoidance decision-making and mediating neural networks that predict alcohol use and symptoms of AUDs over a one-year follow-up period in adults with PTSD, compared to adults with interpersonal violence exposure but no PTSD and healthy comparison adults. Essential to successfully improving clinical prognosis in PTSD are research results that enable better prediction, diagnosis, and treatment based on the individual. There is a paucity of human clinical research investigating interactions between acute alcohol exposure and PTSD that may drive risk for development of AUDs following trauma. Data could identify brain and behavioral mechanisms explaining how alcohol alters an important domain of PTSD contributing to risk for alcohol misuse and development of alcohol problems. Results could pave way for development of novel behavioral and pharmacological methods to treat PTSD and decrease risk for developing comorbid AUDs.

• Inclusion criteria for all participants:

• between 21 and 60 years of age
• having consumed at least 4 (men) or 3 (women) drinks on at least two occasions over the last year
• Inclusion criteria for PTSD participants:

• Meeting diagnostic criteria for PTSD, confirmed by structured interview
• For all subjects exclusion criteria include:

• history of significant medical illness, particularly if possible changes in cerebral tissue
• neurologic abnormality including significant head trauma (loss of consciousness of ≥5-min)
• full Scale IQ <85
• contraindication to MRI scanning
• positive pregnancy test
• severe alcohol use disorder
• current severe cannabis use disorder
• any current substance use disorder (other than alcohol, cannabis, or nicotine)
• scores > 15 on the alcohol Use Disorders Identification Test (AUDIT; part of phone screen)
• ever being in an abstinence-oriented treatment program for alcohol use
• reporting wanting to quit drinking but not being able to
• any medical, religious, or other reasons for not drinking alcohol
• history of heart attack, heart trouble, high blood pressure, diabetes, or liver disease
• an adverse reaction to alcoholic beverages
• reporting never consuming 4 (men) or 3 (women) or more drinks on at least two occasions over the last year
• unwillingness to have a friend or family member drive them home after the alcohol administration sessions
• Additional exclusion criteria for participants in PTSD and IPV-exposed but no PTSD groups:

• not taking medications for >4 weeks (i.e. participants must be stable on meds)
• acute suicidality with intent
• Additional exclusion criteria for participants in IPV-exposure but no PTSD group:

• history of PTSD
• Additional exclusion criteria for healthy comparison subjects also include:

• any prior psychiatric hospitalizations
• lifetime history of a neurodevelopmental disorder, affective disorder, psychotic disorder, suicide attempt, or eating disorder
• greater than 1 month of lifetime psychotropic medication